Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period - a cross-sequential study based on COVAD surveys
Abstract
Objective: Flares of autoimmune rheumatic disease (AIRDs) following COVID-19 vaccination are an outstanding concern in vaccine-hesitant individuals. Therefore, we investigated the incidence, predictors and patterns of flares following vaccination in individuals living with AIRDs using global COVID-19 Vaccination in Autoimmune Diseases (COVAD) surveys. Methods: The COVAD surveys were used to extract data on flare demographics, comorbidities, COVID-19 history, and vaccination details among patients with AIRDs. Flares following vaccination were identified as patient-reported(a), increased immunosuppression(b), clinical exacerbations(c) and worsening of PROMIS scores(d). We studied flare characteristics and used regression models to differentiate flares among various AIRDs. Results: Of 15165 total responses, the incidence of flares in 3453 patients with AIRDs was 11.3%, 14.8%, 9.5%, and 26.7% by definitions a-d, respectively. There was moderate agreement between patient-reported and immunosuppression-defined flares (K = 0.403, p = 0.022). Arthritis (61.6%) and fatigue (58.8%) were the most commonly reported symptoms. Self-reported flares were associated with higher comorbidities (p = 0.013), mental health disorders (MHD) (p < 0.001), and autoimmune multimorbidity (AIDm) (p < 0.001).In regression analysis, the presence of AIDm (OR = 1.4;95%CI:1.1-1.7;p=0.003), MHD (OR = 1.7;95%CI:1.1-2.6;p=0.007), and Moderna vaccine (OR = 1.5;95%CI:1.09-2.2;p=0.014) recipients were predictors of flares. Mycophenolate (OR = 0.5;95%CI:0.3-0.8;p=0.009) and glucocorticoids (OR = 0.6;95%CI:0.5-0.8;p=0.003) were protective.A higher frequency of patients with AIRDs reported overall active disease post-vaccination compared to before vaccination (OR = 1.3;95%CI:1.1-1.5;p<0.001). Conclusion: Flares occur in nearly one in ten individuals with AIRDs after COVID vaccination, with people with comorbidities, especially AID multimorbidity, mental health disorders and use of the Moderna vaccine being particularly vulnerable. Future avenues include exploring flare profiles and optimizing vaccine strategies for this group.
Author
Jagtap, Kshitij
R, Naveen
Day, Jessica
Sen, Parikshit
Vaidya, Binit
Nune, Arvind
Nikiphorou, Elena
Tan, Ai Lyn
Agarwal, Vishwesh
Saha, Sreoshy
Shinjo, Samuel Katsuyuki
Ziade, Nelly
Joshi, Mrudula
Velikova, Tsvetelina
Milchert, Marcin
Parodis, Ioannis
Edgar Gracia-Ramos, Abraham
Cavagna, Lorenzo
Kuwana, Masataka
Knitza, Johannes
Makol, Ashima
Patel, Aarat
Pauling, John D
Wincup, Chris
Barman, Bhupen
Zamora Tehozol, Erick Adrian
Serrano, Jorge Rojas
García-De La Torre, Ignacio
Colunga-Pedraza, Iris J
Merayo-Chalico, Javier
Chibuzo, Okwara Celestine
Katchamart, Wanruchada
Goo, Phonpen Akawatcharangura
Shumnalieva, Russka
Chen, Yi-Ming
Hoff, Leonardo Santos
El Kibbi, Lina
Halabi, Hussein
Sazliyana Shaharir, Syahrul
Hasan, A T M Tanveer
Dey, Dzifa
Gutiérrez, Carlos Enrique Toro
Caballero-Uribe, Carlo Vinicio
Lilleker, James B
Salim, Babur
Gheita, Tamer
Chatterjee, Tulika
Saavedra, Miguel A
Distler, Oliver
Chinoy, Hector
Agarwal, Vikas
Aggarwal, Rohit
Gupta, Latika
R, Naveen
Day, Jessica
Sen, Parikshit
Vaidya, Binit
Nune, Arvind
Nikiphorou, Elena
Tan, Ai Lyn
Agarwal, Vishwesh
Saha, Sreoshy
Shinjo, Samuel Katsuyuki
Ziade, Nelly
Joshi, Mrudula
Velikova, Tsvetelina
Milchert, Marcin
Parodis, Ioannis
Edgar Gracia-Ramos, Abraham
Cavagna, Lorenzo
Kuwana, Masataka
Knitza, Johannes
Makol, Ashima
Patel, Aarat
Pauling, John D
Wincup, Chris
Barman, Bhupen
Zamora Tehozol, Erick Adrian
Serrano, Jorge Rojas
García-De La Torre, Ignacio
Colunga-Pedraza, Iris J
Merayo-Chalico, Javier
Chibuzo, Okwara Celestine
Katchamart, Wanruchada
Goo, Phonpen Akawatcharangura
Shumnalieva, Russka
Chen, Yi-Ming
Hoff, Leonardo Santos
El Kibbi, Lina
Halabi, Hussein
Sazliyana Shaharir, Syahrul
Hasan, A T M Tanveer
Dey, Dzifa
Gutiérrez, Carlos Enrique Toro
Caballero-Uribe, Carlo Vinicio
Lilleker, James B
Salim, Babur
Gheita, Tamer
Chatterjee, Tulika
Saavedra, Miguel A
Distler, Oliver
Chinoy, Hector
Agarwal, Vikas
Aggarwal, Rohit
Gupta, Latika
Citations
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Date
2023-03-24
Type
Article
Subject
Diseases & disorders of systemic, metabolic or environmental origin
Collections
Citation
Jagtap K, R N, Day J, Sen P, Vaidya B, Nune A, Nikiphorou E, Tan AL, Agarwal V, Saha S, Shinjo SK, Ziade N, Joshi M, Velikova T, Milchert M, Parodis I, Edgar Gracia-Ramos A, Cavagna L, Kuwana M, Knitza J, Makol A, Patel A, Pauling JD, Wincup C, Barman B, Zamora Tehozol EA, Serrano JR, García-De La Torre I, Colunga-Pedraza IJ, Merayo-Chalico J, Chibuzo OC, Katchamart W, Goo PA, Shumnalieva R, Chen YM, Hoff LS, El Kibbi L, Halabi H, Sazliyana Shaharir S, Hasan ATMT, Dey D, Gutiérrez CET, Caballero-Uribe CV, Lilleker JB, Salim B, Gheita T, Chatterjee T, Saavedra MA, Distler O; COVAD study group; Chinoy H, Agarwal V, Aggarwal R, Gupta L. Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period - A Cross-sequential study based on COVAD surveys. Rheumatology (Oxford). 2023 Mar 24:kead144. doi: 10.1093/rheumatology/kead144
Journal / Source Title
Rheumatology
DOI
10.1093/rheumatology/kead144
PMID
36961331
Publisher
Oxford University Press